Evaluating the Impact of Singing Interventions on Markers of Cardiovascular Health in Older Patients with Cardiovascular Disease

评估歌唱干预对老年心血管疾病患者心血管健康指标的影响

• 批准号: 10492727
• 负责人: Jacquelyn P Kulinski
• 金额: $ 33.14万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10492727
• 关键词: Adverse event; Affective; Age; Arthritis; Arts; Attitude; Behavior; Biofeedback; Biological; Biological Markers; Cardiac; Cardiac rehabilitation; Cardiovascular Diseases; Cardiovascular system; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Clinical; Clinical Trials; Clinical Trials Design; Complex; Coronary Arteriosclerosis; Data; Dropout; Elderly; Endothelium; Enrollment; Event; Exertion; Future; Gold; Heart; Heart Rate; Hormones; Hydrocortisone; Inflammatory; Instruction; Intervention; Knowledge; Malignant Neoplasms; Measurement; Measures; Mediating; Mental Health; Microcirculation; Moods; Morbidity - disease rate; Music; Nerve; Participant; Patient Self-Report; Perception; Peripheral; Personal Satisfaction; Persons; Phase; Physical Exercise; Physical Rehabilitation; Physical activity; Pilot Projects; Population; Procedures; Process; Psyche structure; Randomized; Recording of previous events; Regulation; Research; Research Design; Resources; Rest; Risk; Salivary; Secondary Prevention; Single-Blind Study; Sinoatrial Node; Sinus; Stress; Students; Study Subject; Target Populations; Testing; Translating; Vascular Endothelium; Visit; Visual; Voice; aging population; arm; arterial tonometry; biobehavior; brachial artery; burden of illness; cardiovascular health; cardiovascular stress test; chronic respiratory disease; comorbidity; cytokine; design; experience; health care settings; heart rate variability; hemodynamics; improved; innovation; mortality; mortality risk; older patient; performing art; preference; prevent; primary outcome; professor; programs; respiratory; saliva sample; salivary assay; secondary outcome; stressor

Project Abstract Cardiovascular disease (CVD) claims more lives each year than cancer and chronic respiratory disease combined. Participation in cardiac rehabilitation (CR) reduces mortality and risk of a major cardiovascular event in secondary prevention populations, including older adults. Older adults are less likely to participate in CR, as comorbidities in this population, including arthritis and chronic obstructive pulmonary disease, make participation difficult. Singing is a physical activity that involves components of the vagal nerves manifested as changes in cardiac autonomic regulation. Unlike physical exercise, the effects of singing on cardiovascular health has not been well-studied. To our knowledge, no studies have evaluated the impact of singing on important cardiac biomarkers. Our hypothesis is that older patients with CVD will have favorable improvement in cardiovascular biomarkers, including, endothelial function and heart rate variability (HRV), after 30 minutes of singing. Our pilot data in 23 subjects provides proof of principle, with a small, but significant, improvement in peripheral vascular endothelial function (measured by peripheral arterial tonometry) after 10 minutes of singing. This pilot study has helped us optimize the clinical trial design for this proposal, which will include a more targeted population, incorporation of personal music preferences, increased duration of singing, inclusion of a music therapist and measurement of brachial artery flow-mediated dilation (FMD), the “gold standard” measurement for vascular endothelial function, as our primary outcome. Our proposal seeks to create, optimize and test two different singing interventions in older patients with CVD. The study will consist of three arms, according to a randomized, single-blind, crossover, sham procedure-controlled design. Sixty-five total participants will each have three visits on three different occasions for the following interventions: (1) a 30-minute period of guided singing from an in- person music therapist, (2) a 30-minute period of singing along to an instructional video including a professor of voice and “inexperienced, older singing student” and (3) a 30-minute rest period without any intervention. We will use biofeedback (target heart rate and BORG Rating of Perceived Exertion) to help subjects optimize the cardiovascular impact of the music interventions. The (2-year) R61 phase of this proposal will assess the feasibility (implementation, practicality, and acceptability) of executing the proposed study design (Aim 1). We anticipate that the R33 phase will take 3 years to complete. The combined R61/R33 phases will be statistically powered to assess changes in FMD and HRV (primary and secondary outcomes, Aims 2a and 2b). An alternative mechanism in Aim 3 will explore the impact of singing on mental health and well-being by measuring salivary cortisol and cytokines and by using a validated visual mood score designed to evaluate performing arts activities in healthcare settings. We will determine which singing intervention, if any, is superior to the other – as this would be important to guide longer and larger clinical trials in the field. Knowledge gained from this proposal will improve our understanding of biologic mechanisms of singing behaviors, as it relates to CVD.

项目摘要